Insurance Scam or Just a Mix-Up?
Hey everyone, I need some advice about a frustrating situation I’ve been dealing with. I visited an orthodontist for wisdom teeth extraction, which is in my insurance network. I paid a $200 consultation fee up front (I know this isn’t covered by insurance). They informed me that the extraction wouldn’t be directly covered, but if I paid in advance and they filed a claim, I might be reimbursed if my insurance approved it. After paying for the procedure, I had my surgery and healed up.
However, when I checked in with my insurance 12 days later, I learned that no claim had been filed. To my surprise, my insurance actually does cover extractions and bone grafts! I should only be responsible for 20% of the costs while they cover 80%.
After discussing this with the orthodontist’s office, the front clerk said she’d pass my message to the billing team. Days went by without any claims being filed, so I started calling daily to resolve the issue. Eventually, I saw that a claim was finally submitted after two weeks of back and forth. However, I had paid a total of $5,356 out of pocket: $5,000 for two bone grafts, $268 for the extractions, and $88 for anesthesia.
When I contacted my insurance to check on the claim, it turned out they had submitted for a completely different treatment that isn’t covered by my plan at all! I honestly feel like this office is trying to take advantage of me. I spoke with the oral surgery department at my insurance, and they confirmed my treatment, instructing the office to submit a new claim. My insurance advised me to wait a week, and if nothing changes, to call them back and file a formal complaint.
Do you think that will make a difference? I’m really anxious about this and just want to get my money back. I’ve definitely learned my lesson—next time, I won’t pay upfront for anything that should be covered by insurance!
I’m really sorry to hear about your frustrating experience. It definitely sounds like you’re dealing with a lot right now, especially with the unexpected costs and lack of communication from the orthodontist’s office. Your instinct to call your insurance company and verify everything is a smart move.
Filing a formal complaint with your insurance is a good step if the orthodontist doesn’t correct the claim. Additionally, consider reaching out to your state’s insurance board or department to report the issue. They can sometimes provide further assistance or guidance on how to navigate disputes like this.
It’s also worth documenting everything – your conversations, dates, and any correspondence. This will be helpful if you need to escalate the issue or take further action.
For the future, paying upfront can be a risky move, and it’s good that you’re aware of that now. I hope you see some resolution soon and that you’re able to get the reimbursement you’re entitled to. Hang in there!